You're going to be a This is Dr. Schreia Trevetti. And this is Dr. Manali Nigam, a neurology resident.

And this is the Core I.M.

Five Pearls podcast bringing you high- high yields evidence-based pearls.

Today we're going to dive into pearls on the geriatric assessment. So when I'm meeting an

older adult patient whether it's in the clinic or in the hospital, I always look at the feet.

Toenails are like the A1C of functional independence.

When you look at the feet and you see this long toenail sign, you really get a sense of how

someone's been managing over the last few months and whether they're able to do this

self-care task or get help for themselves if they can no longer do it.

That's Dr. Andrea Schwartz, a geriatrician at the Boston VA.

She actually gave me that advice to look at the toe nails when we were on rounds together.

So we were seeing this 90 year old whose mobility seemed fine,

so we were asking a physical therapy actually needed to see him.

So, Malle, what do those toenails look like?

Sure enough, his toenails were several

centimeters in length and clearly hadn't been clipped in months so we got PT on board.

Nice. All right so thinking about those toenails a bit more it got me thinking about what are the other high-yield pearls when meeting someone for this

first time especially our geriatric patients. Yeah so let's dive into those

pearls a bit more that we're going to cover. Test yourself after pausing after each of the five questions.

Remember, the more you test yourself,

the deeper your learning gains.

Pearl one, approach to the initial office visit.

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